- UPMC (Pittsburgh, PA)
- …Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... full remote role._ Responsibilities: + Actively participates in the daily utilization management and quality improvement review processes, including concurrent,… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization ... quality patient care and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with… more
- Henry Ford Health System (Clinton Township, MI)
- GENERAL SUMMARY: The Medical Director of Utilization Management shall have responsibility for the medical oversight of activities related to Henry Ford ... REQUIRED: MD or DO. Two (2) years of physician advisor and/or utilization management experience. Medical Staff membership in good standing at Henry Ford… more
- Elevance Health (Durham, NC)
- ** Utilization Management Medical Director - NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... The **Medical Director ** will be responsible for utilization review case management for North Carolina...to increase effectiveness and quality. **Minimum Requirements:** + Requires MD or DO and Board certification approved by one… more
- Humana (Lansing, MI)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Indianapolis, IN)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Little Rock, AR)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- CenterWell (Boston, MA)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical … more
- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... skills, with prior experience participating in teams focusing on quality management , utilization management , and acute inpatient rehabilitation.… more
- Dignity Health (Bakersfield, CA)
- …, remote patient monitoring, and CRM. - Provide backup support to the Medical Director of Utilization Management in medical review activities, peer-to-peer ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
- Elevance Health (Overland Park, KS)
- …clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for ... director provides clinical expertise in all aspects of utilization review and case management . Provides input...of medical services by members. Involved in identifying and managing medical utilization trends, emerging trends and… more
- GMHC (New York, NY)
- Managing Director , Housing WFH Flexible * New York, NY (http://maps.google.com/maps?q=New+York+NY+USA+10018) Description TheManaging Director , Housingis a ... HIV/AIDS. Reporting to theVice President, Housing & Operations, the Managing Director supervises a team of senior...Excel, including: + Data tracking and analysis for case management and program reporting. + Creating and managing… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating...to successfully engage members into care. + Assists Medical Director ( MD ) in projects as needed. Minimum… more
- The Cigna Group (Bloomfield, CT)
- …Summary:** Cigna Healthcare seeks a visionary and results-oriented leader to serve as Managing Director - Local Network Solutions Lead. This role is responsible ... go-to-market product commercialization and provider strategy & solutions, including Utilization Management , EMR integration, and Collaborative Care Agreements.… more
- Grant Thornton (New York, NY)
- As a Managing Director within our Regulatory Compliance & Risk Consulting practice, you will get the opportunity to contribute to our clients' business needs by ... providing in-depth technical knowledge on enterprise risk management , risk management frameworks, and compliance ...client concerns + Meet or exceed targeted billing hours ( utilization ) + Manage firm risk and service quality by… more
- PNC (New York, NY)
- …valued and have an opportunity to contribute to the company's success. As the Managing Director , MBS Portfolio Manager within PNC's Asset & Liability ... + Manages various projects and analytics which may include creation, maintenance and utilization of management reports to help the group meet their goals… more
- Ankura (IL)
- …of their real estate portfolios and capital investments. Role Overview This Senior Managing Director will support Construction Disputes & Advisory - one of ... platform (20+ years total experience) + Ideal candidate will have Construction Management and Project Control experience and experience managing and growing… more
- CVS Health (Springfield, IL)
- …regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM ( Utilization Management ) Medical Director will be a "Work from Home" ... every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more